{"id":4625,"date":"2019-11-15T15:30:13","date_gmt":"2019-11-15T15:30:13","guid":{"rendered":"https:\/\/tvndy.ca\/?p=4625"},"modified":"2019-11-18T01:00:01","modified_gmt":"2019-11-18T01:00:01","slug":"webcast-archive-what-is-a-qaly-and-why-should-you-care","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2019\/11\/webcast-archive-what-is-a-qaly-and-why-should-you-care\/","title":{"rendered":"Webcast archive: What is a QALY and why should you care?"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/s0FezUYHt_Q?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p>In this episode of\u00a0<em>Euthanasia &amp; Disability<\/em>, Amy Hasbrouck &amp; Christian Debray discuss:<\/p>\n<ul>\n<li>What is a QALY and why should you care?<\/li>\n<li>Announcement: special webcast December 6<\/li>\n<\/ul>\n<p>Please note that this text is only a script and that our webcast contains additional commentary.<\/p>\n<p><strong>WHAT IS A QALY AND WHY SHOULD YOU CARE?<\/strong><\/p>\n<ul style=\"font-weight: 400;\">\n<li>This is a Callie [on the video, we present our tricolour cat].\u00a0 She has nothing to do with our webcast topic, except that her name sounds like the acronym for our topic, which is \u201cQuality-Adjusted Life Years,\u201d or QALYs.<\/li>\n<li>QALYs are one tool used in Health Technology Assessment, which is defined in a Canadian\u00a0<a href=\"https:\/\/www.conferenceboard.ca\/temp\/c420251c-f760-45de-9a7c-7b9fa2a110cc\/8943_Health%20Technology%20Assessment__RPT_EN.pdf\">report<\/a>\u00a0as \u201cthe systematic and unbiased [?] evaluation of the efficacy, cost-effectiveness, and socio-economic consequences of drugs, devices, therapies, diagnostics, and health care systems.\u201d QALYs are part of the process for calculating if a medical intervention is cost-effective.<\/li>\n<li>The Partnership to Improve Patient Care in the United States\u00a0<a href=\"http:\/\/www.pipcpatients.org\/uploads\/1\/2\/9\/0\/12902828\/pipc_white_paper_-_measuring_value_in_medicine_-_uses_and_misuses_of_the_qaly.pdf\">reports<\/a>\u00a0that health care spending as a percentage of the U.S. GDP (Gross Domestic Product) has increased from 10% in 1984 to 18% or $3.2 trillion in 2015.\u00a0 The\u00a0<a href=\"https:\/\/www.cihi.ca\/en\/health-spending\">Canadian Institute for Health Information<\/a>\u00a0estimates Canada will spend $264 billion on health care in 2019, or 11.6% of GDP.<\/li>\n<li>The National Council on Disability (NCD)\u00a0<a href=\"https:\/\/ncd.gov\/sites\/default\/files\/NCD_Quality_Adjusted_Life_Report_508.pdf\">explains<\/a>\u00a0that QALYs try to measure both how long a treatment extends life, and how it affects a person\u2019s Health Related Quality of Life (HRQoL). While it\u2019s pretty easy to figure out if a treatment extends life, measuring its impact on quality of life is more complicated. HRQoL can include individual factors like mood, energy, disease, fitness, health risks and income, plus social factors like indoor air pollution, flu severity, accessibility, availability of disability services and supports and workplace safety.<\/li>\n<li>QALYs use a mathematical formula to express quality of life to a single number even though it is affected by a wide range of problems, medical interventions and outcomes.\u00a0 So while it would be possible to compare the impact on quality of life of chemotherapy versus radiation as treatments of cancer (like comparing apples to oranges), it\u2019s much harder to compare chemotherapy for cancer against surgery to repair a cleft palate (like comparing apples to dancing).<\/li>\n<li>The QALY rates the value of life with a disability as a percentage of the value of life without a disability.\u00a0 Hint: it never comes out to more than 100%. The calculation assumes that a year in \u201cperfect health\u201d (assigned a value of 1) is better than being dead (given a value of 0).\u00a0 Things get messy when the points in between are calculated. QALYs usually evaluate the worth of life with a disability based on the preferences of people from the general (non-disabled) population.<\/li>\n<li>NCD points out three main ethical problems with applying QALYs to people with disabilities: \u201c(1) that disability may not actually reduce quality of life; (2) that QALYs discriminate against people with disabilities; (3) that QALYs fail to account for differences between what patients with the same condition value.\u201d\n<ul>\n<li>QALYs based on non-disabled preferences don\u2019t take into account how adjusting to having a disability affects a person\u2019s feelings about their quality of life.<\/li>\n<li>QALYs place greater emphasis on procedures that restore or maintain perfect health.\u00a0 Because people with disabilities or chronic conditions are seen as having a lower potential for health, treatments that extend their lives or improve their quality of life may result in fewer QALYs than the same treatment given to a non-disabled person, even if the treatment provides an equal benefit.<\/li>\n<li>Also, because QALY formulas often include average life expectancy, and many disabling conditions reduce the number of years people live, people with disabilities and older people will get a lower QALY score for the drug or treatment they need.<\/li>\n<li>There are many different scales used to calculate a QALY, that can produce widely varying results. A study of how patients rated the value of hip replacements compared four QALY scales, which yielded four different values; from 0.10 to 0.22.\u00a0 Since the proof of a scientific theory is based in part on whether results can be reproduced, it would be a stretch to say that the calculation of the QALY is \u201cscientific.\u201d<\/li>\n<li>Single number scores do a poor job at pinpointing what people want. As the Partnership for Improved Patient Care noted: \u201cAn intervention that restores a patient to full health for one full year would be assigned a QALY score of \u20181.\u2019 At the same time, a different intervention that provides two years of moderate health could also result in a value of \u20181.\u2019 Yet these are two very different outcomes.\u201d<\/li>\n<\/ul>\n<\/li>\n<li>In 1990, the Oregon Health Services Commission used QALYs to rank the relative value of healthcare condition-treatment pairs to determine what services would be covered by government-funded health insurance (Medicaid). The final recommendations included some strange priorities; for example, tooth capping ranked higher than emergency appendectomy.\u00a0 In 1992 the federal department of Health and Human Services rejected the proposed list because that it discriminated against people with disabilities (in violation of the Americans with Disabilities Act). However according to the PIPC white paper \u201cOregon continues to use a modified prioritized list that does take cost and cost-effectiveness into consideration.\u201d<\/li>\n<li>Because of problems with QALYs, the Patient Centered Outcomes Research Institute (PCORI) in the U.S. is prohibited by law from using \u201ca dollars-per-quality adjusted life year \u2026 as a threshold to establish what type of health care is cost effective or recommended.\u201d\u00a0 The law that prohibits using QALYs is the Affordable Care Act, a.k.a. Obamacare.<\/li>\n<li>The United Kingdom\u2019s National Institute for Health and Care Excellence (NICE) uses a QALY-based system. The NCD notes that health outcomes for people with some \u201cchronic illnesses and disabilities (such as \u2026 lung cancer) are notably worse in the United Kingdom than in the United States.\u201d\u00a0 France\u2019s\u00a0<a href=\"https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2012-10\/choices_in_methods_for_economic_evaluation.pdf\">National Authority for Health<\/a>\u00a0also uses Cost Utility Analysis and QALYs to evaluate health care spending.<\/li>\n<li>Information about the use of QALYs in Canada isn\u2019t easy to find.\u00a0 A search on the website of the Canadian Institute for Health Information turned up only one document that mentioned QALYs, even though the leading organizations that evaluate drugs, medical services and devices use QALYs in their evaluation process.<\/li>\n<li>In Canada, where each province manages its own health care system, there is no national standard.\u00a0 Several non-governmental organizations recommend policy on health care to provincial leaders.\n<ul>\n<li>The Canadian Agency for Drugs and Technologies in Health (CADTH) was established in 1989, and has become the leader in evaluating medications, health services and technologies.\u00a0 The latest CADTH\u00a0<a href=\"https:\/\/www.cadth.ca\/sites\/default\/files\/pdf\/guidelines_for_the_economic_evaluation_of_health_technologies_canada_4th_ed.pdf\">guidelines<\/a>\u00a0(from 2017) call for calls for using QALYs in the \u201cmeasurement and valuation of health.\u201d \u201cA QALY is the recommended outcome to capture health effects when conducting a cost-utility analysis (CUA).\u201d<\/li>\n<li>The CADTH is part of a pan-Canadian Health Technology Assessment Collaborative, which includes, Quebec\u2019s l\u2019Institut national d\u2019excellence en sante\u0301 et services sociaux (INESSS), Alberta\u2019s Institute of Health Economics (IHE), and Health Quality Ontario (HQO).\u00a0 These organizations use QALYs in determining what drugs, services and devices will be offered.<\/li>\n<\/ul>\n<\/li>\n<li>This is a really big and important subject.\u00a0 It has all the ingredients that make a topic unpleasant to learn about: math, jargon, acronyms, detail, academic writing, government policy, information overload, discrimination and large, faceless organizations that no one has ever heard of before.\u00a0 The take-away message would be that there is a select group of people who are making decisions about what drugs or health services are covered. The people who develop these policies:\n<ul>\n<li>Work for organizations that are not accountable to voters or the public;<\/li>\n<li>Most likely represent privileged positions in society;<\/li>\n<li>Probably don\u2019t know (and maybe don\u2019t care) that the methods they\u2019re using put disabled people and other minorities at a disadvantage;<\/li>\n<li>Are making decisions that can have a life-or-death impact on us without our being aware.<\/li>\n<\/ul>\n<\/li>\n<li>We\u2019ve provided some links for more information about measuring the economic value of health care.<\/li>\n<li><a href=\"https:\/\/nccid.ca\/wp-content\/uploads\/sites\/2\/2015\/03\/GBD_Factsheet_FINAL_E.pdf\">Understanding Summary Measures Used to Estimate the Burden of Disease: All about HALYs, DALYs and QALYs<\/a>.<\/li>\n<li><a href=\"https:\/\/ncd.gov\/sites\/default\/files\/NCD_Quality_Adjusted_Life_Report_508.pdf\">NCD Report: Quality-Adjusted Life Years and the Devaluation of Life with Disability<\/a><\/li>\n<li><a href=\"http:\/\/www.pipcpatients.org\/uploads\/1\/2\/9\/0\/12902828\/pipc_white_paper_-_measuring_value_in_medicine_-_uses_and_misuses_of_the_qaly.pdf\">PIPC White Paper \u2014 Measuring Value in Medicine: Uses and Misuses of the QALY<\/a><\/li>\n<li><a href=\"https:\/\/www.cadth.ca\/sites\/default\/files\/pdf\/guidelines_for_the_economic_evaluation_of_health_technologies_canada_4th_ed.pdf\">Guidelines for the Economic Evaluation of Health Technologies, 4th Edition<\/a>\u00a0from the Canadian Agency for Drugs and Technologies in Health<\/li>\n<li><a href=\"https:\/\/www.hqontario.ca\/Portals\/0\/documents\/evidence\/reports\/hta-methods-and-process-guide-en.pdf\">Health Technology Assessments: Methods and Process Guide<\/a>\u00a0from Health Quality Ontario<\/li>\n<li><a href=\"https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2012-10\/choices_in_methods_for_economic_evaluation.pdf\">Choices in Methods for Economic Evaluation<\/a>\u00a0at the Health Authority of France<\/li>\n<li><a href=\"https:\/\/www.cihi.ca\/sites\/default\/files\/proms_background_may21_en-web_0.pdf\">PROMs (Patient-Reported Outcome Measures) Background Document<\/a>\u00a0(2015) from the Canadian Institute for Health Information<\/li>\n<\/ul>\n<p><strong>ANNOUNCEMENT: SPECIAL WEBCAST DECEMBER 6<\/strong><\/p>\n<ul style=\"font-weight: 400;\">\n<li>TVNDY is planning to present our December 6 webcast in the form of online discussions, using Zoom conferencing software.<\/li>\n<li>Several events have conspired to prompt us to (re)try this innovation.\n<ul>\n<li>The ruling of the Qu\u00e9bec Superior court in the\u00a0<em>Truchon<\/em>\u00a0case which declared the &#8220;reasonably foreseeable natural death&#8221; eligibility criterion unconstitutional;<\/li>\n<li>Parliament&#8217;s plan to modify the medical assistance in dying statute to conform to the\u00a0<em>Truchon<\/em>\u00a0decision;<\/li>\n<li>The five year review of the MAiD law, which may or may not happen, and will probably be limited because the first official MAiD report isn&#8217;t due out until March of next year.<\/li>\n<li>More cases reported in the media of problems with MAiD and other life-ending practices (like people being pressured to sign &#8220;do not resuscitate&#8221; orders).<\/li>\n<\/ul>\n<\/li>\n<li>When we launched our webcast in 2013, we imagined it as an online discussion, but we&#8217;ve never had a big enough audience to make it happen that way.\u00a0 So we&#8217;re trying it again, as a periodic event, in the hopes that, with a few years experience and more than 400 English and French webcasts to draw on,\u00a0we can create a supportive environment to talk about these very difficult situations. Details coming soon.<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nThis week, we discuss different ways to calculate the cost-effectiveness of health care interventions, and the effect of these analyses on people with disabilities.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2019\/11\/webcast-archive-what-is-a-qaly-and-why-should-you-care\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: What is a QALY and why should you care?&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2019\/11\/webcast-archive-what-is-a-qaly-and-why-should-you-care\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: What is a QALY and why should you care?&rdquo;<\/span>&hellip;<\/a><\/div>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[92],"tags":[121,45,424,645,118],"class_list":["post-4625","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-euthanasia-disability","tag-health-care-en","tag-national-council-on-disability","tag-qaly","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4625","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/comments?post=4625"}],"version-history":[{"count":1,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4625\/revisions"}],"predecessor-version":[{"id":4626,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/4625\/revisions\/4626"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=4625"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=4625"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=4625"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}